Editor’s Note: Following news reports about efforts to downplay the number of suicides among U.S. veterans (like the one we published on April 22, below), Sen. Daniel K. Akaka, D-Hawaii, chairman of the Senate Veterans' Affairs Committee, called for the resignation of Dr. Ira Katz from his post as the chief mental health officer at the Department of Veterans Affairs.

"Dr. Katz's personal conduct and professional judgment have been called into question. I believe veterans, and the Department of Veterans Affairs, would be best served by his immediate resignation," Akaka wrote.

Senior officials at the Veterans Administration debated internally how to downplay evidence of a stunning number of suicides and suicide attempts among veterans who were treated or had sought help at VA hospitals around the country, according to newly disclosed internal VA e-mails.

On Feb. 13, 2008, Ira Katz, the VA’s mental health director, and Ev Chasen, the agency’s chief communications director, exchanged e-mails discussing P.R. strategy for handling this troubling news, according to evidence made public Monday in a federal court case in Northern California.

The exchange came in the context of how to handle inquiries from CBS News, which was reporting on the surge of suicides among U.S. veterans – reaching an average of 18 per day – with part of that rise attributed to soldiers returning from the wars in Iraq and Afghanistan.

In an e-mail headlined “Not for the CBS News Interview Request,” Katz notified Chasen that the VA had identified some 1,000 suicide attempts per month among war veterans treated by the VA.

“Shh!” Katz wrote to Chasen. “Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?”

Chasen responded to Katz with suggestions about how to avoid too much negative attention to the data.

“Is the fact that we’re stopping [suicides] good news, or is the sheer number bad news? And is this more than we’ve ever seen before?” Chasen wrote to Katz, adding:

“It might be something we drop into a general release about our suicide prevention efforts, which (as you know far better than I) prominently include training employees to recognize the warning signs of suicide.”

He also disputed that veterans from Iraq and Afghanistan face any special risk of suicide.

“VA's latest data do not demonstrate an increased risk of suicide among [Afghan and Iraqi theatre] veterans compared to the age and gender matched American population as a whole,” Katz said.

Three days after the testimony, on Dec. 15, Katz painted a grimmer picture in an e-mail to Brig. Gen. Michael J. Kussman, the Veteran Health Administration’s undersecretary for health.

Katz’s e-mail said that from the total population of U.S. veterans from all wars, an average of 18 vets commit suicide each day. Katz said the data, which the VA obtained from the Center for Disease Control, showed that 20 percent of suicides in the United States are identified as war veterans.

“VA’s own data demonstrate 4-5 suicides per day among those who receive care from us,” Katz wrote.

On March 20, 2008, CBS News reported that it had obtained an internal VA study showing that 1,784 vets who received VA services still committed suicide in 2005, an increase from 1,403 such suicides in 2001.

CBS News also quoted Rep. Bob Filner, D-California, chairman of the House Veterans’ Affairs Committee, complaining that the VA had withheld this important data from Congress.

“Given the fact that we keep asking for data and they say, ‘we don’t have any,’ yes, it surprises me,” Filner told CBS News. “If we can’t get the correct information, we can’t do our job. We can’t prevent every suicide but you can prevent a whole lot of them and it’s our duty as a nation to do that.”

Suicide Epidemic

The internal VA e-mail exchange discussing P.R. strategy was disclosed at a federal trial in Northern California where two veterans’ advocacy groups – Veterans for Common Sense and Veterans United for Truth – have filed a class-action lawsuit against the VA.

The lawsuit alleges that a systematic breakdown at the VA has led to an epidemic of suicides among war veterans. The suit claims the VA has turned away veterans who have sought help for post-traumatic stress disorder and were suicidal.

Some of these veterans, the lawsuit claims, later took their own lives.

The lawsuit wants a federal judge to issue a preliminary injunction to force the VA to immediately treat veterans who show signs of PTSD and are at risk of suicide and to overhaul internal system that handles benefits claims.

Underscoring just how under-prepared the VA was for the number of PTSD cases that would emerge from the Iraq and Afghanistan wars, documents released to support the veterans’ lawsuit show that prior to the U.S. invasion of Iraq the VA believed it would likely see a maximum of 8,000 cases where veterans showed signs of PTSD.

Last week, the RAND Corporation released a study that said about 300,000 U.S. troops sent to combat in Iraq and Afghanistan are suffering from major depression or PTSD, and 320,000 received traumatic brain injuries.

Since October 2001, about 1.6 million U.S. troops have deployed to the wars in Iraq and Afghanistan. Many soldiers have completed more than two tours of duty meaning they are exposed to prolonged periods of combat-related stress or traumatic events.

“There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan," said Terri Tanielian, a researcher at RAND who worked on the study.

“Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation. Unfortunately, we found there are many barriers preventing them from getting the high-quality treatment they need.”

Paul Sullivan, executive director of Veterans for Common Sense, has been warning lawmakers about this problem for several years.

“The scope of PTSD in the long term is enormous and must be taken seriously,” Sullivan told a congressional committee in July 2007. “When all of our 1.6 million service members eventually return home from Iraq and Afghanistan, based on the current rate of 20 percent, VA may face up to 320,000 total new veterans diagnosed with PTSD.”

“If America fails to act now and overhaul the broken DoD and VA disability systems, there may a social catastrophe among many of our returning Iraq and Afghanistan war veterans. That is why VCS reluctantly filed suit against VA in Federal Court. ... Time is running out.”

“Congress should legislate a presumption of service connection for veterans diagnosed [with] PTSD who deployed to a war zone after 9/11,” Sullivan said. “A presumption makes it easier for dedicated and hard-working VA employees to process veterans’ claims. This results in faster medical treatment and benefits for our veterans.”

Yet despite Sullivan’s dire predictions and calls for legislative action, the issue has not been given priority treatment by lawmakers. Instead, Congress continued to fund the war in Iraq to the tune of about $200 billion and will likely approve another $108 billion next month.

VA’s Backlog

Meanwhile, a backlog of veterans’ benefits claims continue to pile up at the VA.

The VA said it has hired more than 3,000 mental healthcare professionals over the past two years to deal with the increasing number of PTSD cases, but the problems persist.

In opening statements in the federal court case, Richard Lepley, a Justice Department attorney, defended the VA, calling its network of hospitals a "world-class healthcare system."

But Gordon Erspamer, the lead attorney representing the two veterans groups, said the VA has arbitrarily denied coverage to thousands of vets, that it takes nearly a year to decide whether it will provide coverage to veterans suffering from PTSD, and takes as long as four years to address veterans appeals cases.

“Seeking help from the Department of Veterans’ Affairs ... involves a two-track system,” according to the plaintiff’s trial brief. “A veteran will go to the Veterans’ Health Administration for diagnosis and medical care; and a veteran goes to the Veterans’ Benefits Administration to apply for service-connection and disability compensation.

“VA is failing these veterans as they move along both of these parallel tracks. They are not receiving the healthcare to which they are entitled (and where they do receive it, it is unreasonably delayed) and they are not able to get timely compensation for their disabilities, which means that they have no safety net.

“These two problems combine to create a perfect storm for PTSD veterans: they receive no treatment, so their symptoms get worse; and they receive no compensation, so they cannot go elsewhere for treatment. The failings of these two separate but interrelated systems are what this action seeks to address.”

The lawsuit alleges that numerous VA practices stemming from a 1998 law violate the constitutional and statutory rights of veterans suffering from PTSD by denying veterans mandated medical care.

Justice Department attorneys argued in court papers filed in March that Iraq and Afghanistan veterans were not "entitled" to the five years of free healthcare upon their return from combat as mandated by Congress in the "Dignity for Wounded Warriors Act."

Rather, the VA argued, medical treatment for the war veterans was discretionary based on the level of funding available in the VA's budget.

But during a court hearing before U.S. District Court Judge Samuel Conti, Dr. Gerald Cross, principal deputy under-secretary for health at the Veterans Health Administration, said veterans of Iraq and Afghanistan were not only entitled to free healthcare, but he said, "there is no co-pay."

Warnings Ignored

Chris Scheuerman, a retired Special Forces masters sergeant, testified before a congressional committee in March that there is an urgent need for mental health reform in the military.

Scheuerman said his son, Pfc. Jason Scheuerman, went to see an Army psychologist because he had become suicidal.

The Army psychologist wrote up a report saying Jason Scheuerman “was capable of (faking) mental illness in order to manipulate his command,” according to documents the soldier’s father turned over to Congress.

“Jason desperately needed a second opinion after his encounter with the Army psychologist,” Chris Scheuerman testified before the Armed Services Committee’s Military Personnel Subcommittee.

“The Army did offer him that option, but at his own expense. How is a PFC (private first class) in the middle of Iraq supposed to get to a civilian mental healthcare provider at his own expense?” Scheuerman said.

“I believe a soldier should be afforded the opportunity to a second opinion via teleconference with a civilian mental healthcare provider of their own choice.”

Jason Scheuerman shot himself with a rifle on July 30, 2005. The 20-year-old’s suicide note said, “Maybe now I can get some peace.”

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